Blood /Blood Product Transfusion

Patient selection
Indication for transfusion
Hemoglobin of less than 9 g/dl in labor.
Acute blood loss(abruptio placenta , placenta previa , PPH ,ectopic)
Disseminated intravascular coagulation
Check Blood send for cross Match in patients like:
High risk obstetric patient
Patient for induction of labour
Thrombocytopenia
Bleeding or clotting disorders
Gynecological major cases
Details entered on forms and sample
Blood requisition form is filled by same resident who collected the blood.
Sample collection in EDTA bulb
Full name written in ( block letters) and clearly on sample .
IPD number (No OPD OR CASUALTY NUMBER)
Ward number
Unit name
Old Blood Group and Cross Match report attached to the form.
Diagnosis
Reason for transfusion
Hemoglobin percentage written
Signature and designation of the person
Presence of errors (fill a new form instead of correcting the old one).
When Blood bag comes from blood bank
Different Types of labels For different Blood group

Check

Different Types of labels For different Blood group

Blood group	Label color
Blood group A	Yellow
Blood group B	Pink
Blood group AB	White
Blood group O	Blue

• Do Not rely on color codes
• Check: written matter on label on bags…..
• Label is of Blood Bank KEM HOSPITAL
• Unit No
• Date of collection
• Date of expiry
• Blood group and Rh typing
• HIV Tested on

Getting blood from other blood bank
BGCM forms have 'NO STOCK' written on it.
Blood availability in other blood bank (recognized by KEM blood bank): contact operator (No. 9) ask to connect to various blood banks (nos available with operator).
Send relative to KEM blood bank for a requisition slip to get blood from other blood bank. For standalone blood banks, send patient's blood sample along with the request.
Patient's relative is informed by doctors on how the blood or blood products should be brought. Ensure Cryoprecipitates are    transported with ice packs.	.
Relative takes the blood to KEM blood bank after getting it from outside. Blood from standalone blood banks is cross matched by the concerned blood banks and is used after checking the reports. (KEM blood banks does not cross match the sample again.)
Blood and blood product are cross matched and issued from KEM blood bank. They have now KEM label.
Platelets are agitated and not allowed to stand still during transport.
Rapid cross match
Valid indication.
Assistant Professor on duty is consulted.
Consent of patient after complete information regarding the high risk.
Assistant Professor’s signature on written call along with blood sample and form.
Look for reactions.
Routine cross match
Blood for cross match is sent one day prior to surgery
Blood sample is sent before 12 noon.
In case of holiday, blood sample is sent one day prior to holiday.
The word 'Routine' written on form sent
The date and time when blood is required is mentioned.
Procedure prior to blood transfusion
Ensure Informed valid written consent is taken for blood /blood product transfusion.
Base line vital parameters– pulse rate, blood pressure, temperature, respiratory rate are recorded.
The patient's identification is verified.
Blood bag is not issued in advance and is issued only when required.
The label of blood and blood product bag and transfusion slip are checked.
The patient full name, IPD number, bag unit number, blood group and Rh are same on label, form, and paper.
The bag is checked for date of collection, date of issue, date of expiry, testing is done for HIV.
The blood bag is checked for any clotting, leak, frothing, discoloration, and/or fungus.
All previous reports of blood group are checked and confirmed to be the same.
Procedure during starting the transfusion
A vein on forearm is selected.
All aseptic and antiseptic precautions are taken.
Hands are washed.
Sterile gloves are worn.
A 170-260 micron blood filter set is used for transfusion.
Blood filter blood set is inserted aseptically with no touch technique.
All air is removed from the IV tubings.
Methylated spirit is applied at the site of cannulation.
An 18 gauge i.v. cannula is used. And fix it
The cannula is fixed to the skin.
Blood transfusion started within half hour of issue.
Warming of blood bag is not done in case of a slow transfusion.
Special precautions
Air not introduced into the administration set or the blood components or blood products.
Ensure transfused blood component/blood product is mixed gently by inversion to resuspend the product.
No drug is added to the blood or blood product.
Notes to be written on Indoor paper
Name, designation of the person starting the transfusion and date are written in case paper.
The information written on bag slip/label is recorded on transfusion notes.
Fresh instructions (orders) are written for the nurse.
Blood is started at rate of 1ml/min .
Vital parameters are checked after 15 minutes.
If no blood transfusion reaction seen, the transfusion rate id increased to 4ml/minute.
Total blood/blood product transfused within 4 hour of issuing it.
Monitoring of blood transfusion
Symptoms of transfusion reaction like breathlessness, itching, loin tenderness, etc are watched for.
The following parameters are checked after 15 minutes, and if normal, every 30 minutes till 1 hour after completion of blood transfusion.
General condition
Temperature
Pulse rate
Blood pressure
Respiration rate
Skin Rashes
Bleeding from any site
Completion of blood transfusion
Following completion of the transfusion, post transfusion information is documented on the patient’s chart.
Blood bag label is removed and stuck to the blood transfusion notes after transfusion completion and not initially.
Discarding empty bags
Bag discarded In Red bag.
IV cannula discarded after cutting in sharps (non puncture containers).
Concurrent fluids and medications
Ensure concurrent fluids administered as far as possible from the transfusion site (different arm.)
Ensure medication given from another IV access if required.
Ensure drugs, etc. not injected in the blood bag or blood products
Ensure blood bags not punctured with needles, except for insertion of the blood set.
Change of IV transfusion set
Transfusion set is changed after four consecutive units of red cells have been transfused.
Set is confirmed to be not occluded .
Set is changed at least once every 24 hours
Manufacturer’s requirements for use are met.
Indications for blood warmers
Routine warming of blood is not indicated
A blood warmer is indicated for:
Large volume rapid transfusions of >50 ml/kg/hour
Exchange transfusions.
Plasma exchange for therapeutic apheresis in adults.
Patients with clinically significant cold agglutination antibody.
Blood products transfusion: Special precautions
Platelets: continuously agitated till transfused.
Cryoprecipitates: storage at 5 degree C till actual use
in ice pack in transport stage.
Fresh Frozen Plasma: no sample ia sent as blood grouping is not necessary.
Blood is not used
Blood bags are issued only when required immediately for transfusion.
Unused blood bags are not left in department's refrigerators.
Blood and blood products are not wasted.
Blood bag out of temperature controlled storage for greater than 30 minutes is not used.
Discard unused blood and blood product bag(s) in yellow bag. (Blood bank never takes bags back.)
Blood transfusion reaction
Diagnostic symptom(s) and sign(s) are recorded.
Transfusion is stopped immediately.
Action is taken with speed because of the possible life- threatening nature of acute transfusion reactions.
Assistant Professor on duty is informed when a reaction occurs.
Any adverse reaction to the transfusion of blood or blood components is reported to blood bank personnel immediately by the Unit concerned.
Remove Unit and administration set are removed.
The intravenous cannula is left in place and a new administration set is put up.
Intravenous saline infusion is started.
Injection chlorpheniramine 10 to 20 mg by is given intravenously.
Injection hydrocortisone 100 mg is given.
Injection adrenalin 0.5 ml 1:1000 dilution is given intramuscularly in case of anaphylatic shock. It is repeated after 15 minutes if there is no significant response. (Intramuscular adrenaline is the first line treatment for anaphylaxis, with intravenous adrenaline reserved for unresponsive anaphylaxis or circulatory collapse)
Blood transfusion reaction information
Transfusion reaction form is obtained from the blood bank.
All columns in the transfusion reaction form are filled.
Blood unit and administration set are removed and sent to the blood bank.
Blood samples are taken from the other arm and sent to blood bank and other respective laboratories for the following tests:
Repeat group / cross match / DCT (goes to blood bank)
Coagulation studies, biochemistry – renal and liver function tests and uirnalysis.
Checklist after transfusion reaction
Transfusion is stopped immediately.
Remove Unit and administration set are removed.
The intravenous cannula is left in place and a new administration set is put up.
Intravenous saline infusion is started.
Injection chlorpheniramine 10 to 20 mg by is given intravenously.
Injection hydrocortisone 100 mg is given.
Injection adrenalin 0.5 ml 1:1000 dilution is given intramuscularly in case of anaphylatic shock. It is repeated after 15 minutes if there is no significant response. (Intramuscular adrenaline is the first line treatment for anaphylaxis, with intravenous adrenaline reserved for unresponsive anaphylaxis or circulatory collapse)
In the case of simple, urticarial-type reactions with no other symptoms or signs, the patient is given antihistaminics and the transfusion may be continued at a slower rate.
Monitoring Parameters: Dangerous if values raised as below:
The following parameters are checked.
Temperature ≥1.5°C above baseline.
Hypotension/shock or hypertension.
Tachycardia.
Tachypnea, wheeze, stridor.
Rigors or chills.
Nausea, vomiting or pain (local, chest, back).
Bleeding
Skin rash